• Medics need to prepare for registrar responsibility in a fixed environment.
  • NHS culture and medical school culture need to “knit” together.
  • Medics need to be used differently in the system.

More needs to be done to help junior doctors prepare for their work in the NHS, according to Health Education England’s medical director.

In a wide-ranging interview with HSJ, Wendy Reid said efforts were needed to knit together the culture of both medical schools and the NHS to help doctors starting out their training.

She also set out HEE’s vision for the new cohort of doctors starting this August who will take longer to start their specialist training as part of moves to give core medical trainees more of a generalist foundation.

Dr Reid, a consultant gynaecologist at the Royal Free London Foundation Trust, said changes as a result of its its Foundation Programme Review, which focuses on the transition period between medical school and work as a doctor, meant there was a need to “knit together” medical school culture and NHS culture adding there was “a lot more we could do”.

“Preparing to work starts way back at medical school and we have to get them ready to doctor,” she said. “[We are hearing] reports of ‘I’m not ready to work’.”

Dr Reid said the NHS needed to ensure it “offers the right support” to doctors in this transition period and said there was a need for trusts to support doctors from widening participation schemes who may have “come through difficulties”.

“Let’s have a look at the [end of the] spectrum where perhaps they need more support. Do they want something different?” she said.

Dr Reid, who is HEE’s executive director for education and quality said while standards for specialist training were fixed, HEE “reserves the right” to change how trainee doctors get there.

HEE launched its new three-year internal medical training programme this August, which replaces the previous two years of core medical training before doctors choose their specialty and become registrars.

However, Dr Reid said that the new IMT programme is about giving medics “time to grow and learn in a more fixed environment geographically”.

She said the changes were not about “robbing Peter to pay Paul” but were instead about ensuring medics had generalist skills and tools for the “scariest job in the hospital”.

“That first year as a medical registrar, you’ve moved hospital, you’re in an environment you don’t know and that’s not supporting practice.”

She said despite the frequent rotations, the NHS needs to make doctors feel “part of something” and “welcome introductions from chief executives, that sort of thing, will make this work”.

“We are very interested in the generalist bit of early training,” she added.

She referred to the five new medical schools, which were announced last year, and said there is a “huge amount more time spent in general practice and primary care settings”.

“[This is a] different approach to getting a medical degree, so you could use the word generalist, but you can just say it’s a different approach,” she said.

Earlier this year, the long-term plan for the NHS announced plans to incentivise more doctors to train as generalists rather than specialising in a specific area of medicine. 

HEE also recently published “set piece” reports on enhancing supervision for doctors and an update on its enhancing junior doctors working lives work, which Dr Reid said, was about “doctors having more control over their lives, being heard and having a voice”.

“Enhancing junior doctors working lives and other bits of medical reform are about professional autonomy,” Dr Reid said. “We’ve learnt that doctors do not want to go along one linear route and they want to move around and develop different skills. It is about creating an environment around a young doctor that gives them a sense of autonomy.”

She added that further work reviewing the Annual Review of Competency Progression aimed to “reduce bureaucracy” and was another part of HEE’s medical education reform.

More but different

Dr Reid stressed that a “positive investment” in education and “training is how you get the workforce you need” and said its not just about recruiting more medics but also how they can be used differently in the system.

“I think the focus on the workforce is long overdue,” she said. “The NHS is a great education and training organisation and we need to maximise that. Otherwise the workforce won’t stay.”

She stressed that the People Plan – which is expected two months after the spending review – is an example of how to “change things in the system when we work together”.

“The next steps for HEE is to continue this collaborative way of working, drive educational standards up and make sure we are reflecting what students and trainees need,” Dr Reid said.

She acknowledged that despite increasing the domestic supply of medics, international recruitment will continue and said HEE must make sure it is a “two-way process”.

“There’s an expectation that the NHS has got something to offer and that offer has to be made clearly, transparently and ethically,” she said.